CHAPTER TWO LITERATURE REVIEW
The chapter on literature review starts with a contextual overview of Ethiopia as a country and its health care delivery system and continues with the breastfeeding practices and policies, the relationships between social cognitive theory and the promotion of breastfeeding, and an illustration of the application of the social cognitive theory in the context of this study.
Ethiopia is located in the north-eastern part of Africa, and has a total surface area of approximately 1.1 million square kilometres. The country is land-locked and is sharing a border with six countries: Eritrea and Sudan in the north, Djibouti and Somalia in the east, Kenya in the south and South Sudan in the west. It is the second most populous sub-Saharan African country, with a population of about 84 million with 2.6% annual growth rate. About 83.6% of the population lives in rural areas with an average national household size of 4.7 and the illiteracy rate for adult females at 77% (WHO 2013a).
Ethiopia consists of nine self-governing regional states (Afar, Amhara, Benshangul-Gumaz, Gambella, Harari, Oromia, Somali, Southern Nations Nationalities and People, Tigray) and two administrative cities (Addis Ababa and Dire Dawa). The administrative city of Addis Ababa covers an area of approximately 526.99 square kilometres with a density of 5,535.8 people per square kilometre. It has an estimated total population of 2,917,295. Report indicates that 34.6% of the total population consists of women of the reproductive age (CSA 2007). The total population of Addis Ababa is projected to reach 12 million within 20 years. Administratively, the regional states and the two administrative cities are divided into districts and kebeles (the smallest administrative unit in Ethiopia).
The decentralisation of power to regional governments and local communities is the basis for all types of public service delivery. This approach is believed to bring closer community participation at a grass-roots level (WHO, 2013a).
Health Care Delivery and Health Indicators
The Ethiopia’s health care delivery system is decentralised and organised around three levels of health care delivery. The first level known as a woreda or district health system or primary health care unit (PHCU) comprised of a primary hospital with a catchment area of 60,000-100,000 people, health centres each deserving 15,000-25,000 population and satellite health posts deserving 3,000-5,000 population. These structured are connected to each other by a referral system.
The second level consists of general referral hospitals covering a population of 1-1.5 million people each; and the third level comprised of specialised referral hospital covering a population of 3.5 -5 million people (FMOH 2010). According to the 2012 report of the Federal Ministry of Health, Addis Ababa accounts for 11 public and 34 private hospitals, and 50 health centres; with the ratios physician to population of 1:2225, health officers to population of 1:9187, nurse-midwife to population of 1:21,118, and nurse to population ratio of 1:965 (FMOH, 2012).
Although there have been major health improvements recently, Ethiopia still has high morbidity and mortality rates and overall health status remains relatively poor. According to the 2012 health and health related indicators (FMOH, 2012), life expectancy is 59 years (58.4 years for males and 60.4 for females). The latest report (UN & WHO 2014) suggests that Ethiopia’s has an under-five mortality rate and maternal mortality ratio of 68 per 1000 live births and 420 per 100,000 live births respectively, the life time risk of maternal death among women of reproductive age group of one in 52 mothers, a total fertility rate of 4.6 per women, and the adolescent birth rate of 87 per 1000 girls. The same report indicated that the rates of: 52% for family planning coverage, 19% for focused antenatal care attendance, 10% for skilled-delivery, and 7% for postnatal care attendance; and 29% of under-five year old children underweight (UN & WHO 2014).
According to the health and health related indicators (FMOH, 2012:23), Addis Ababa has a total fertility rate of 1.5, a crude birth rate of 23.3 per 1000 populations, and crude death rate of 6.3 per 1000 population. The infant and under five mortality rates during the same year were at 40 and 53 per 1000 live births respectively, with 22.1 and 3.3% of children under three years moderately and severely malnourished (FMOH 2012).
BREASTFEEDING PRACTICES AND POLICIES
The practices of feeding a child with breast milk direct from the breast or expressed are often defined in terms methods, time of initiation and duration. These variables are associated with various terms such as bottle-feeding, complementary feeding, cup-feeding, early cessation of breastfeeding, exclusive breastfeeding, full breastfeeding, median duration of breastfeeding, optimal infant and young child feeding, and replacement feeding (WHO 2002). Table 2 provides the glossary of terms related infant and young child feeding practices.
HIV and AIDS pose a great challenge in breastfeeding practices. Although breastfeeding is the norm throughout most of sub-Saharan Africa and many other parts of the world, there are challenges in linking breastfeeding HIV positive mothers with needed services and support at both the facility and community levels (UNAIDS 2012). In 2013, it was estimated that half of all new episodes of HIV transmission to children around the world occur during the breastfeeding period when the majority of lactating women are not receiving the prophylaxis necessary to prevent HIV transmission (USAIDS 2013).
Evidence shows that the decision-making on infant feeding was not only based on knowledge about medical risks, but also on the social risks regarding disclosure, rejection and stigma experienced by HIV positive mothers (Leshabari et al 2007). In developing countries, most HIV positive mothers practiced exclusive formula feeding, and mixed feeding; contributing for the low rate of EBF as well as high risk of mother to child transmission of HIV (Olatona, Ginigeme, Roberts & Amu 2014).
CHAPTER ONE ORIENTATION TO THE STUDY
1.2 BACKGROUND AND RATIONALE FOR THE STUDY
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 AIM AND OBJECTIVES OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 THEORETICAL FOUNDATION
1.7 DEFINITION OF KEY CONCEPTS
1.8 OPERATIONAL DEFINITION OF KEYS CONCEPTS
1.9 ETHICAL STATEMENT
1.10 STRUCTURE OF THE REPORT
CHAPTER TWO LITERATURE REVIEW
2.2 CONTEXTUAL OVERVIEW
2.3 BREASTFEEDING PRACTICES AND POLICIES
2.4 SOCIAL COGNITIVE THEORY AND PROMOTION OF BREASTFEEDING
CHAPTER THREE RESEARCH METHODOLOGY
3.2 METHODOLOGICAL FOUNDATION
3.4 PHASE ONE OF THE STUDY
3.5 PHASE TWO OF THE STUDY
3.6 ETHICAL CONSIDERATIONS
3.7 SCIENTIFIC INTEGRITY OF THE STUDY
CHAPTER FOUR PRESENTATION AND DISCUSSION OF PHASE ONE MAIN FINDINGS
4.2 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDESNTS
4.3 PRENATAL SOCIAL COGNITIVE BREASTFEEDING BEHAVIOUR
4.4 RESPONDENTS OVERALL PRENATAL SOCIAL COGNITIVE BREASTFEEDING BEHAVIOUR
4.5 ACTUAL BREASTFEEDING PRACTICES
4.6 SOCIAL COGNITIVE PREDICTORS OF EXCLUSIVE BREASTFEEDING
4.7 SUMMARY OF THE RESULTS
4.8 DISCUSSION OF THE MAIN RESULTS
CHAPTER FIVE PRESENTATION AND DESCRIPTION OF THE STRATEGIES
5.2 DESCRIPTION OF THE PANEL OF EXPERTS
5.3 RESULTS OF THE STRATEGIES DEVELOPMENT PROCESS
5.4 DESCRIPTION OF THE STRATEGIES
CHAPTER SIX CONCLUSION, RECOMMENDATIONS AND LIMITATIONS OF THE STUDY
6.3 LIMITATIONS OF THE STUDY
GET THE COMPLETE PROJECT